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Achieving Health Equity: Tools for a National Conversation on Racism


APHA President and Noted Scholar Camara Jones Wants to Talk – and She’s Got Stories to Tell

May 11, 2016

Many students of public health are familiar with The Gardener’s Tale, the classic and widely taught allegorical framework describing the levels of racism. Published in 2000, its author, Camara Jones, MD, MPH, PhD, has continued to build on the analogy she created 16 years ago – and also has created new allegories to enable people to talk about racism (not “race, but racism” she emphasizes). It is a scourge that, she says, threatens not only the well-being and self-esteem of its victims, but also undermines productivity and future of the nation.

Jones took the podium in the Stein Auditorium at Drexel’s Dornsife School of Public Health on May 9 to deliver the 2016 Mann Health and Human Rights Memorial Lecture. The lecture is named for founding dean Jonathan Mann, who established the school’s commitment to health as a human right – a value that was interwoven through Jones’s presentation.

Jones says she created her Gardener’s Tale years ago based on a personal experience, that occurred when she and her husband were planting a couple of flower boxes outside their new home in Baltimore. One box had no soil, so they bought fresh soil to fill it – then planted seeds in both boxes – red flowers in one, pink in the other. Later, they discovered that the red seeds planted in the rich, new soil had sprouted and were thriving, while the pink seeds in the old depleted soil were stunted. The vignette became the basis for an extended allegory that defined three levels of racism. Institutionalized racism results when the gardener likes the robust red flowers best – and fails to take action to provide rich soil or fertilizer to the struggling pink blooms. Personally-mediated racism is exemplified when the gardener chops down the pink blossoms before they go to seed because they are inferior to the red flowers he favors. Finally, internalized racism is defined by the pink flowers themselves preferring red pollen to pink pollen, because they have internalized their poor treatment and now believe that red is naturally better – and prettier – than pink.

Fast forward to the present, and Jones has developed several new and thought-provoking allegories on racism. There is the cliff analogy of when, how and whom should be rescued from harm as they march to the edge: some people are allowed to fall – and only an ambulance may be able to help them; others land in a safety net halfway down, but have no way of getting safely back to the top of the mountain. Still others don’t fall, because there’s a fence to keep them on high ground. Adding another dimension, some people seem to stay safely away from the cliff’s edge, while others seem to move quickly to the precipice: demonstrating how differences in exposures and opportunity can define the social determinants of health equity.

Yet another allegory involves colorful Japanese paper lanterns at a garden party – that make moths dancing inside them appear to be the color of the paper enclosure, pink, yellow blue, orange – rather than real moth colors, which range from brown to shades of gray. “The message here is that the colors we think we see are due to the lights by which we look,” said Jones. “These colored lights distort and mask our true variability. So what is ‘race’? It’s a social classification, not a biological descriptor… the social interpretation of how one looks in a ‘race’-conscious society.”

These analogies can help to make difficult and uncomfortable discussions about racism and equity possible – and Camara Jones is a strong advocate for getting these conversations started, to advance changes in society. She directed the audience to explore the International Convention on the Elimination of all forms of Racial Discrimination (CERD), the anti-racism treaty adopted by the UN General assembly in 1965 (signed by the US in 1966, and ratified by Congress in 1994). She also suggested they take a look at CERD’s 2014 concluding observationsand visit the Anti-Racism Collaborative on the APHA website.

“Racism saps the strength of our entire society by wasting human resources,” she concluded. “There’s genius in all communities” she, says, and it is in our collective best interest to harness rather than suppress it.

Of course, there are barriers, among them our “a-historical culture” that defines the present as disconnected from the past, and deems relative advantages and disadvantages as happenstance; narrow self-interest, with limited sense of collective efficacy or the role of systems in defining the status quo; and the myth of meritocracy – which holds that denying the existence of racism and working hard levels the playing field for all.

“I believe people are born good – not hateful or selfish,” said Jones. “We need to know our history, and let go of the myth of meritocracy, value each other, and instead of becoming sealed off – strive to be more connected.”


Camara Jones, MD, MPH, PhD, is one of five physicians in her immediate family: her dad is a doctor, as are her twin sisters. Mom was a mathematician with a master’s degree; she came of age when women were discouraged from attending medical school, but she encouraged her daughters to go for it. And so they did.

About that fifth doctor? Jones married a pediatrician.